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Depression and Glycemic Control in Elderly Ethnically Diverse Patients With Diabetes

The IDEATel Project

¹ Departments of Psychiatry and Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, New York
² Department of Medicine, Veterans Affairs Medical Center, Syracuse, New York
³ Division of Endocrinology, Joslin Diabetes Center, SUNY Upstate Medical University, Syracuse, New York
⁴ Research Division, Hebrew Home for the Aged, Bronx, New York
⁵ Stroud Center, Columbia University, New York, New York
⁶ Naomi Berrie Diabetes Center, Columbia University, New York, New York
⁷ Department of Biomedical Informatics, Columbia University, New York, New York
⁸ Departments of Medicine and Epidemiology, Columbia University, New York, New York

Address correspondence and reprint requests to Paula M. Trief, PhD, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210. E-mail: triefp{at}upstate.edu

OBJECTIVE—The purpose of the study was to investigate the effect of comorbid depression on glycemic control and on response to a telemedicine case management intervention for elderly, ethnically diverse diabetic patients.

RESEARCH DESIGN AND METHODS—Medicare beneficiaries in underserved areas were participants (n = 1,665) in the Informatics for Diabetes Education and Telemedicine (IDEATel) project and randomized to a telemedicine case management intervention or usual care. The data analyzed include baseline demographics (age, sex, race/ethnicity, marital status, insulin use, years of education, years of diabetes, and pack-years smoked) and measures of glycemic control (HbA_1c [A1C]), comorbidity, diabetes symptom severity, functional disability and depression, and 1-year (n = 1,578) A1C. The association between depression and glycemic control was analyzed cross-sectionally and prospectively.

RESULTS—At baseline, there was a significant correlation between depression and A1C and a trend for depression to predict A1C when other factors were controlled. However, in prospective analyses, depression did not predict change in A1C, either in the control or intervention group.

CONCLUSIONS—In this large sample of elderly diabetic patients, a weak relationship between depression and A1C was found, but depression did not prospectively predict change in glycemic control. Thus, there is no evidence that depression should be used to exclude patients from interventions. Also, we should evaluate the impact of depression on outcomes other than glycemic control.

Abbreviations: CARE, Comprehensive Assessment and Referral Evaluation • CMMS, Center for Medicare and Medicaid Services • IDEATel, Informatics for Diabetes Education and Telemedicine • PCP, primary care provider

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